Provider Demographics
NPI:1427234319
Name:HEFTA, ARLYNN LEE (HEARINGAIDSPECIALIST)
Entity type:Individual
Prefix:
First Name:ARLYNN
Middle Name:LEE
Last Name:HEFTA
Suffix:
Gender:M
Credentials:HEARINGAIDSPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 COLLEGE DR S
Mailing Address - Street 2:SUITE 16
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3537
Mailing Address - Country:US
Mailing Address - Phone:701-662-2765
Mailing Address - Fax:701-662-2765
Practice Address - Street 1:425 COLLEGE DR S
Practice Address - Street 2:SUITE 16
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3537
Practice Address - Country:US
Practice Address - Phone:701-662-2765
Practice Address - Fax:701-662-2765
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDH-0023237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56141Medicaid